Active NPI
Mario Villalobos Medran, MS, RDN, LDN
- Registered Dietitian
- Chicago, IL
National Provider Identifier
1639753908
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 164008364
- Practice address
- 1943 S May St # 1F
Chicago, IL 60608-3359 - Phone
- (312) 549-8866
- NPI assigned
- May 12, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 164008364 | IL | Primary |
Addresses
Primary practice location
1943 S May St # 1F
Chicago, IL 60608-3359
Mailing address
945 N Ridgeway Ave
Chicago, IL 60651-3838
Phone (913) 263-4824
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1620777600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620777600000",
"number": "1639753908",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "945 N RIDGEWAY AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606513838",
"telephone_number": "913-263-4824"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1943 S MAY ST # 1F",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606083359",
"telephone_number": "312-549-8866"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VILLALOBOS MEDRAN",
"first_name": "MARIO",
"credential": "MS, RDN, LDN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-05-12",
"last_updated": "2021-05-12",
"certification_date": "2021-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "164008364",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.